Basic Information
| Provider Information | |||||||||
| NPI: | 1346648144 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BULUSU | ||||||||
| FirstName: | SHAILAJA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4341 PIEDMONT AVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946114792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105471630 | ||||||||
| FaxNumber: | 5109231944 | ||||||||
| Practice Location | |||||||||
| Address1: | THREE EMBARCADERO CENTER | ||||||||
| Address2: | LOBBY LEVEL | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154952225 | ||||||||
| FaxNumber: | 4154942228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2014 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.